Unitatea autorizata ................... Data ...........
Adresa ................................
BULETIN DE SCHIMB VALUTAR
Seria ....... Nr. ....................
1. Numele si prenumele ........Tara ............. Actul de identitate ..........
2. Suma incasata Curs Comision Suma platita
de la client clientului
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L.S. Casier Semnatura clientului
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